Day 1 :
Burjeel Hospital, UAE
Keynote: Vomiting of Surgical Significance
Time : 09:30-10:10
Prof. Dr. Amin El-Gohary completed his MBBCh in 1972 and his Diploma in General Surgery in 1975 at Cairo University, Egypt. He became the Chief and Head of the Department of Pediatric Surgery of a large government hospital. He also held post as the Clinical Dean of Gulf Medical College, Ajman for 3 years. Prof. Dr. Amin is well known in Abu Dhabi for his extensive interest and involvement in scientific activities. He was the President of the Pediatric Surgical Association of UAE. Prof. Amin is a member of several associations in Paediatric surgery: Executive Member of the International Society of Intersex and Hypospadias Disorder (ISHID), British Association of Pediatric Surgery, Egyptian Association of Pediatric Surgeons, Asian Association of Pediatric Surgeons, and Pan African Association of Pediatric Surgery. He is also the founder and member of the Arab Association of Pediatric Surgeons.
Vomiting is common symptoms among neonates, infants and children and the majority are managed by pediatrician or pediatric gastroenterologist. However there are types of vomiting that should be referred and managed by pediatric surgeons. These include the following:
1- Bilious vomiting however small or intermittent
2- Projectile vomiting
3- Frothy neonates
The cardinal signs and symptoms of bowel obstruction are : vomiting, abdominal distension , abdominal pain and constipation. Of which bilious vomiting is considered the most important sign. Any Baby who vomits bile should be considered as having an underling intestinal obstruction until proved otherwise
Mal-rotation in particular carries a high mortality rate if associated with volvulus , despite its minimal symptoms in the form of intermittent bilious vomiting.
The presentation highlights the different pathological condition associated with vomiting, and their clinical, radiological and surgical management.
Vrije University, Belgium
H Reynaert, MD, PhD is a Professor of Physiology and Pathophysiology at the Vrije Universiteit Brussel. He is Head of the Hepatology unit at the University Hospital Brussels (UZ Brussel) and Senior Researcher in the Liver Cell Biology lab at the Vrije Universiteit Brussel. He is the past President of the Belgian Association for Study of the Liver (BASL) and current President of the Flemish Society of Gastroenterology (VVGE). He is the member of many national and international societies, including AASLD, EASL, and AGA. He is interested in many aspects of liver disease, including cirrhosis and its complications, viral hepatitis and Non-Alcoholic Liver Disease (NAFLD).
Non-Alcoholic Fatty Liver Disease (NAFLD) is defined by the presence of steatosis in >5% of hepatocytes. It comprises the spectrum of simple steatosis (Non-Alcoholic Fatty Liver or NAFL), and a progressive form, Non-Alcoholic Steatohepatitis (NASH), in which steatosis is accompanied by inflammation, fibrosis or even cirrhosis and hepatocellular carcinoma. NAFLD is associated with insulin resistance and its prevalence is increasing rapidly, paralleling the prevalence of metabolic syndrome. It is estimated that in some countries 30% of the population has NAFLD, but the prevalence in patients with diabetes mellitus type 2 (DMT2) is much higher. Moreover, in DMT2 patients, NASH is more prevalent. Therefore, it is imperative to screen patients with DMT2. In recent years, non-invasive methods to identify patients at risk have been developed. These include imaging techniques and several scoring systems consisting of clinical and biological data. In high risk patients, liver biopsy, which remains the gold standard for diagnosing and grading disease severity, should be performed. Patients at risk should be treated and strict follow-up to detect complications early is essential. We suggest an algorithm as depicted in Figure 1. Treatment of NASH is difficult and unsatisfactory. Weight loss by diet and life style changes (exercise) remains the cornerstone of treatment. It has been shown that ≥7% weight loss resulted in histological improvement. Weight loss is however problematic in this patient group: bariatric surgery improves all histological lesions in NASH including fibrosis. Up to now, no drug treatment has been shown to unequivocally improve NASH. PPAR-gamma agonists, vitamin E, FXR agonists, GLP-1 agonists and PPAR-alpha/delta agonists have shown favorable effects, but large phase 3 trials are lacking. A multitude of new drugs, targeting different metabolic pathways are being developed and tested. Hopefully, we will be able to treat patients with NASH more optimally in the near future.